ITJ Prototype

ITJ Banner: Prototype
Toolbar (image map) Links to: Institute, Home, Orientation, Course&Registration, Professional Services, Support

APPLICATION FORM TO PARTICIPATE IN THE
ITJ PROTOTYPE

PART 1

We are very pleased with your interest in the ITJ Prototype. As mentioned earlier, the prototype exercise will enable ITJ to ensure that the on-line modules offered to Japanese language teachers for professional development are of the highest quality. We believe that by involving teachers in the testing and development of ITJ modules via this Prototype exercise, we will be able to create a professional development program that will significantly contribute to building educational skills.

The application procedure is divided into two parts, the first part will provide us with your biographical information and the second part consists of a brief survey form. Both parts will need to be completed for your application to be considered. After you click on the "Submit Part I of the Application Form" button after completing Part I, Part II of the form will appear on your screen with your name already in place. You may then complete and submit this form. When you have completed Part II, please click on the submit button at the bottom of the form. A Thank you screen will appear. Use your browser's "back" button to return to the ITJ web site.

Teachers selected to participate in the Prototype will not need to pay any fees to take the module. Also, all supplemental reading material needed to complete the module will be provided to the participants free of charge. All participants will also receive a certificate of completion from ITJ and The Laurasian Institution for successfully completing the module.

Again, thank you for considering applying to join the ITJ Prototype Exercise. The application period will only last two weeks. As soon as it is complete, all applicants will be informed of their status.

First Name:
Initial:

Last Name:


Primary E-Mail Address:

(e.g., name@school.edu)

Home Address 1:


Home Address 2:


City: State:
;
Postal Code:

Home Phone:
Home Fax:

Work Phone:
Extension:

Work Fax:



The name of the school where you are a teacher:


Which grade level (s) do you teach Japanese? (Please select all that apply.)
Elementary Middle School High School Community College

How many years have you been teaching Japanese? (please enter the number)

What is your level of education: BA BS MA MS PhD

Are you a native, or a non-native Japanese language speaker?

Are you a participant in JALEX? Yes | No

Login and Password

Please indicate below the login name and password you would like to use to gain access to ITJ course materials. We suggest that for a login name, you use your first initial and your last name. For example: JSmith. You may choose any short, easy to remember password you wish. Type in both your login name and password in the boxes below. You will need to first type in your password in the "password" box, then again in the "confirm" box. When you receive notification of your successful registration, you will be shown your login name and password, which you may then use to access ITJ course materials. Be sure to keep a record of your login name and password.

Login ID:


Password:
Confirm:


| About this website | Site Map | Feedback |
© 1997 The Laurasian Institution